Provider Demographics
NPI:1659532794
Name:AGEPATI, RADHA GAYATRI (MD)
Entity Type:Individual
Prefix:DR
First Name:RADHA
Middle Name:GAYATRI
Last Name:AGEPATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:20925 PROFESSIONAL PLZ
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-3403
Mailing Address - Country:US
Mailing Address - Phone:571-442-8182
Mailing Address - Fax:571-918-9168
Practice Address - Street 1:20925 PROFESSIONAL PLZ
Practice Address - Street 2:SUITE 310
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3403
Practice Address - Country:US
Practice Address - Phone:571-442-8182
Practice Address - Fax:571-918-9168
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
VA01012546262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program